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Free AHM-250 Exam Braindumps (page: 47)

Page 46 of 92
PDF with 367 Questions

The Courtland PPO maintains computerized records that include clinical, demographic, and administrative data about individual plan members. The data in these records is available to plan providers, ancillary service departments, pharmacies, and others inv

  1. a data warehouse
  2. a decision support system
  3. an outsourcing system
  4. an electronic medical record (EMR) system

Answer(s): D



The criteria used to identify and measure healthcare quality are generally divided into three categories: structure, process, and outcomes measures. Structure measures, which relate to the nature and quality of the resources that a health plan has available

  1. length of time patients have to wait at the office to be seen by a provider
  2. percentage of plan physicians who are board-certified
  3. percentage of children receiving immunizations
  4. number of patients contracting an infection in the hospital

Answer(s): B



The data evaluation stage of utilization review (UR) includes both administrative reviews and medical reviews. One true statement about these types of reviews is that:

  1. An administrative review must be conducted by a health plan staff member who is a medical professional.
  2. The primary purpose of an administrative review is to evaluate the appropriateness of a proposed medical service.
  3. UR staff members typically conduct a medical review of a proposed medical service before they conduct an administrative review for that same service.
  4. One purpose of a medical review is to evaluate the medical necessity of a proposed medical service.

Answer(s): D



The Employee Retirement Income Security Act (ERISA) requires health plan members who receive healthcare benefits through employee benefit plans to file legal challenges involving coverage decisions or plan administration at the federal level. Under the te

  1. contract damages, which cover the cost of denied treatment
  2. compensatory damages, which compensate the injured party for his or her injuries
  3. punitive damages, which are designed to punish or make an example of the wrongdoer
  4. all of the above

Answer(s): A






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